Medi-scare, from Both Sides, Now

1995, the high point of Newt Gingrich’s Republican Revolution, was also the thirtieth anniversary of the kind of massive government program—government takeover, some might call it—that Gingrich and his allies, and their successors, should oppose: Medicare. It was also a year when Rush Limbaugh still had a television show. So on July 26, 1995, the actual week of the anniversary, Limbaugh was on air talking about Medicare.

“Well, this is the birthday week of Medicare. Happy birthday to you… whoopie do—folks, one of the biggest boondoggles in American social program history,” he said.

The rest of the segment was about Democrats’ rhetoric about the program and Republicans’ proposed changes to it—rhetoric he termed “Mediscare,” saying of the Democrats, “If anybody wants to kill it it’s you guys, because you’re going to end up destroying the people who provide the money for it.”

By then, this was a familiar sort of dance for conservatives. On the one hand, they often opposed the very idea of Medicare. On the other, given the rapid growth in its popularity since its passage, they were stuck in the position of having to explain why they didn’t actually oppose it and didn’t want to get rid of it, and why their plans for reforming it were better than those proposed by the party that actually backed the program in the first place.

So for decades any discussion of Medicare during a Presidential election has been practically certain to come down to a simple split: Democrats accuse Republicans of wanting to gut the program, while Republicans accuse Democrats of fear-mongering. It may not be exciting, or enlightening, but it’s tested, and it works.

No surprise, then, to see Paul Ryan, in his debate with Joe Biden Thursday night, warning voters about his opponent:

They haven’t put a credible solution on the table. He’ll tell you about vouchers. He’ll say all these things to try and scare people.

And later:

A voucher is you go to your mailbox, get a check, and buy something. Nobody’s proposing that. Barack Obama four years ago running for President said if you don’t have any fresh ideas, use stale tactics to scare voters. If you don’t have a good record to run on, paint your opponent as someone people should run from.

And again:

This is what politicians do when they don’t have a record to run on: try to scare people from voting for you.

These were predictable lines, but this time around they were ironic as well. Thanks to Obamacare, in this election Republicans have been just as interested in playing the game they used to call “Medi-scare” as their Democratic colleagues. Indeed, if Mitt Romney hadn’t picked Ryan as his running mate, the G.O.P. may have been the real party of Medi-scare this year.

So, yes, Ryan spent plenty of time Thursday night absorbing hits from Biden on this front. But when he wasn’t taking the hits, or complaining about them, he was dishing out some of his own. This is just one example of several:

Look what—look what Obamacare does. Obamacare takes seven hundred and sixteen billion dollars from Medicare to spend on Obamacare. Even their own chief actuary at Medicare backs this up. He says you can’t spend the same dollar twice. You can’t claim that this money goes to Medicare and Obamacare.

And then they put this new Obamacare board in charge of cutting Medicare each and every year in ways that will lead to denied care for current seniors.

For the record, Ryan said several things there that were misleading or just untrue. The seven hundred and sixteen billion dollars he refers to, for instance, isn’t really being taken from Medicare—and people on Medicare aren’t having their benefits slashed by that much. It’s a result mainly of cuts in payments to providers and insurance companies, and other efficiencies. And during their arguments about Medicare, Obamacare, and health care generally, both Ryan and Biden spun and misled on the specifics. But in the broader strokes, it was Biden—and his fellow Democrats over the years—who had it right. That’s because Ryan has fallen victim to that same dilemma about Medicare that captured Limbaugh almost twenty years ago now.

Ryan has a reputation for bold wonkery, for floating proposals that he believes in, and damn the political consequences. The truth, though, is that as he and his plans have become more influential within the G.O.P., and thus more visible to Democrats and to voters, Ryan has made significant changes to his position on Medicare, all of which had the effect of pushing him to the center.

In his original “Roadmap,” released in 2008, Ryan proposed full privatization of Medicare, changing it from a “defined benefit” program—one in which the government pays for whatever it covers, regardless of the cost—to a “defined contribution” system, in which seniors would be provided with ninety-five hundred dollars annually with which to pay for private insurance, and would be responsible for any costs above that. By 2010, Ryan had bumped that figure up to eleven thousand dollars; by 2011, it was fifteen thousand dollars. In the latest version of his plan, he’s just plain dropped the idea of full privatization in favor of partial privatization—traditional Medicare would be kept around, if only as an option that seniors could choose over private plans.

It must have been dispiriting for Ryan to think back on all that Thursday night: he was forced to compromise on his ideology for political reasons, but then he gets hit anyway. And no amount of complaining could make it stop.